Healthcare Provider Details

I. General information

NPI: 1184832966
Provider Name (Legal Business Name): YONGCONG LIU L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 POPPY LN
BERKELEY CA
94708-1407
US

IV. Provider business mailing address

59 POPPY LN
BERKELEY CA
94708-1407
US

V. Phone/Fax

Practice location:
  • Phone: 510-527-1329
  • Fax: 510-527-1329
Mailing address:
  • Phone: 510-527-1329
  • Fax: 510-527-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberL.AC5344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: